Why ADHD Is A Real Concern For Canadian Women

Most women go undiagnosed until middle age.

ADHDPhoto Credit: Shutterstock

Shannon Nagel didn’t happen upon her Attention Deficit Hyperactivity Disorder (ADHD) diagnosis the way many kids do. Unlike the thousands of Canadian children who are diagnosed with the neurobiological condition while in school — often flagged by teachers as inattentive, hyperactive or unfocused — she was well into her 40s when her symptoms finally made sense.

After returning from Belgium in 2013, the then 44-year-old faced three challenges: finding a new apartment in Canada, studying for the GRE exam and applying to grad school. “I had just finished a degree in cognitive neuroscience, and I found myself completely incapable of doing anything,” recalls Nagel, a Burlington, Ont. resident. When her mother sent her some information on ADHD she had found online, adding “These things are exactly you,” Nagel demurred. “I said: ‘That’s not me.’ It took me a little while for it to sink in.”

How she found clarity.

Nagel had struggled with anxiety (Make sure you know these 4 coping strategies.) and depression for years. She had grappled with restlessness and regulating her emotions. But it was only when a psychiatrist diagnosed her a year after her return to Canada that she finally had some clarity. Suddenly, she was a middle-aged woman with a condition that’s most often associated with children. But as she soon realized, she was far from alone.

Statistics show that 2.9 percent of adults have ADHD. But many women like Nagel are slow to be diagnosed; it’s a function of gender (girls are often better at masking symptoms), misinformation about the condition, and coping strategies learned by women over the years. While adult women still suffer from memory issues, mood swings, an inability to multitask or impulsivity, these symptoms often get chalked up to cognitive issues like dementia or hormonal fluctuations brought on by menopause. And these women get missed, only to be diagnosed as things in their lives — jobs, daily activities, relationships — start to fall apart.

“We’re still missing more girls in childhood,” says Heidi Bernhardt, president and executive director of the Centre for ADHD Awareness, Canada in Markham, Ont., who says that girls are more likely to have the primarily inattentive presentation of ADHD, meaning it doesn’t include hyperactivity and impulsivity, so the red flags aren’t as obvious. “And, because girls are also socialized differently in general, they tend to suppress any disruptive symptoms to a greater degree,” says Bernhardt.

Her midlife diagnoses.

These girls grow up to be moms who have kids with ADHD. “We see a lot of adults who get diagnosed after their kids are diagnosed,” says Dr. Doron Almagor, director of the Possibilities Clinic in Toronto, many of whom are mothers in their 40s and 50s. He says that because ADHD is genetic, psychiatrists are increasingly looking at parents to see if one or both have symptoms. It’s often at that point that the multitasking mom — the one who looks after school lunches, daycare drop-offs, her job, and caring for elderly parents — may show signs of strain.

“At some point, they can’t do it anymore,” says Dr. Almagor. Because ADHD affects the prefrontal cortex, the part of the brain that affects executive functioning, it can severely impair managing multiple tasks. Motivation suffers, as does attention to detail. Women with ADHD may find they need more and more external tools to function — such as alarm clocks and lists.

But things can start to fall through the cracks, says Bernhardt. Bills may go unpaid and appointments missed. “Someone who could keep everything together suddenly can’t,” she says. “A lot of times, these women can crash and burn.” She says women with ADHD will often question themselves: “Why am I forgetting this?”

That in turn can lead to conflict in a relationship, as dinner dates are missed and birthdays and anniversaries are forgotten. Bernhardt says these gestures are often seen as deliberate by partners rather than unintentional. “Very often, the spouse can get resentful,” says Bernhardt. “We see break-ups and divorce.”

And that in turn can lead to mental health issues, which are more common in people with ADHD than the general population. According to a 2017 Norwegian study, ADHD sufferers are four to nine times more likely to be diagnosed with anxiety, depression and conditions such as bipolar disorder. Check out these 7 brain-boosting nutrition tips for your mental health.

Coping strategies.

Sharon Vinderine, founder and CEO of Parent Tested Parent Approved, a product certification and influencer firm, had always tried to manage her inattentiveness and hyperactivity. “I’ve always been a person who doesn’t stand still,” says the 46-year-old. “I’ll blurt something out. And unless I set myself up for it, I have no ability to focus.”

So two years ago, she opted for psychological testing and was given a diagnosis of ADHD. “I had always suspected I had it,” says Vinderine, who was 43 at the time. Though she tried Biphentin, a commonly prescribed stimulant that helps boost certain brain chemicals, she didn’t want to be reliant on medication. Instead, like many women, she developed a series of strategies that have helped her handle her busy life.

The first was familial buy-in. “I have taught my kids and husband not to ask me to do something at the same time,” she says. “My attention span is less than that of a gnat.” Instead, she tells them to ask her one thing at a time, with only one family member speaking at a time.

She has begun journalling, writing down lists of tasks she needs to complete. She also makes time for focusing, which involves putting on headphones, and finding a quiet space. And she uses alarms and timers constantly — “to take vitamins, manage the school schedule, work.”

Vinderine has also seen how exercise helps manage her symptoms. (Find out if exercise is really the prescription you need to improve your mental health.) She works out three times a week. “It leaves me clear-headed and less lethargic — and lets me get things done,” she says.

Why lifestyle matters.

Dr. Almagor suggests women who have received a formal diagnosis discuss medications with their doctor. He says good nutrition can also be helpful. So can fish oil supplements which, though not scientifically proven to ease symptoms, do help some people. And he feels that stress management is helpful, something that’s achieved through enough sleep, meditation and exercise such as yoga. Here’s how to choose the right type of yoga for you.

For women who find they need more than medication to manage their day-to-day lives, Bernhardt suggests trying cognitive behavioural therapy with a psychologist to overcome negative thinking, reduce stress, and put coping and organizational strategies into place. Women can also do work with an ADHD coach, who will work with them to put strategies for daily impairments into place. But she cautions there is no magic bullet when it comes to managing ADHD. “There’s no cure,” she says. “There are a variety of treatment options that should be used in combination and tailored to the individual.”

Nagel is well aware that her diagnosis is a life-long challenge filled with good days and those when she has trouble regulating her emotions. But now on several medications, she’s joined an ADHD meetup group that has provided a lot of support. “The experience of women is different from men,” she says. “It’s about being able to sit down with other adults who have it — and share what works for us.” “It’s invaluable being in a room of people who get you.”

Editor’s Note: Name is changed to protect privacy. 

Originally Published in Best Health Canada